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BUREAU OF FIREARMS
FIRST NAME
MIDDLE NAME
CITY
STATE
ZIP
CITY
STATE
ZIP
DATE OF BIRTH
Mo
Day
U.S.
CITIZEN?
SEX
PLACE OF BIRTH
(State or Country)
Yr
YES
NO
DAYTIME PHONE #
AND Country
of Citizenship
If no, enter
AR# or I-94#
ID NUMBER
B. Firearm(s) Information
Long Gun
Rifle
If Long
Gun:
Handgun
If
Shotgun Handgun:
Semiauto
Single Shot
Revolver
Other:
SERIAL NUMBER
BARREL LENGTH
IN.
CM.
DATE ACQUIRED
Mo
Day
ACQUIRED FROM:
Family Member
Rifle
If Long
Gun:
Handgun
Shotgun
Private Party
Gun Show
Other:
(Specify relationship)
Yr
Long Gun
Firearms Dealer
COLOR
If
Handgun:
Semiauto
Single Shot
Revolver
Other:
SERIAL NUMBER
BARREL LENGTH
IN.
CM.
DATE ACQUIRED
Mo
Day
ACQUIRED FROM:
Family Member
Rifle
If Long
Gun:
Handgun
Shotgun
DATE ACQUIRED
Mo
Day
If
Handgun:
Semiauto
Single Shot
Revolver
Other:
ACQUIRED FROM:
Family Member
Yr
(Specify relationship)
Private Party
Other:
(Specify relationship)
Yr
Long Gun
Firearms Dealer
Firearms Dealer
Private Party
Other:
SERIAL NUMBER
Gun Show
BARREL LENGTH
IN.
CM.
COLOR
C. Declaration
I declare under penalty of perjury (Sections 126 and 672 PC) that all statements made by me on this application are true and complete. I
expressly authorize DOJ to perform firearms eligibility checks of all relevant state and federal databases, including the National Instant
Criminal Background Check System. I also understand that if I currently possess/own firearms and the results of this check reveal that I
am ineligible either to lawfully possess or purchase firearms, I must relinquish any and all firearms in my possession.
SIGNATURE
DATE
INSTRUCTIONS ON REVERSE
FD 4542A (10/04)
Usually located on the frame of the handgun, and on the receiver of a long gun. May be
all numeric or a combination of alpha and numeric characters.
Make
The manufacturer of the firearm (e.g., Beretta, Ruger, Glock, Smith and Wesson).
Model
The model name of the firearm (e.g., 3032 Tomcat, KP95, 17C, Mini 14).
Caliber
Firearm Origin
The country of origin of the firearm (e.g., United States, Russia, China, Italy).
Barrel Length
Enter the barrel length as stated in your owner information, or measure the barrel length
by closing the action of the firearm and inserting a wooden dowel down the barrel until it
stops. Mark the dowel with a pen at the muzzle. Remove the dowel and measure the
distance between the inserted end of the dowel and the pen mark.
Part C. Declaration
You must sign and date the application.